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General NPI Number Information
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NPI Number | 1568713550
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Entity Type | Organization
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Legal Business Name | WELLSTAR HEALTH SYSTEM
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 3630 EDENBOURGH PL
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City | MARIETTA
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State | GA
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Zip | 30066-3081
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Country | US
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Telephone | 404-388-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 3630 EDENBOURGH PL
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City | MARIETTA
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State | GA
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Zip | 30066-3081
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Country | US
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Telephone | 404-388-4800
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALISON KRAUSE
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Credential | MD
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Telephone | 770-426-3828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 1336113919
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License Number State | GA
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